St. Louis Public Radio | By Sarah Fentem
PublishedJuly 29, 2024 at 5:00 AM CDT
The Washington University Transgender Center continues to offer some treatments to transgender patients under 18 after state legislators passed a law last year that prohibits doctors from providing minors with comprehensive gender-affirming care.
Wash U officials recently sought to clarify that Washington University would continue some services after a former caseworker at the center said that the pediatric center would close.
Jamie Reed, a former caseworker who worked at the center until 2022, made that claim in a recent op-ed published in the St. Louis Post-Dispatch.
What is the transgender center?
The Washington University Transgender Center “provides health care for transgender and non-binary people in a welcoming, affirming environment,” according to its website. It’s staffed by Barnes-Jewish Hospital and St. Louis Children’s Hospital employees and provides gender-affirming care for adults and pediatric patients.
Gender-affirming care includes a variety of medical and mental health care treatments and social support for people whose sex at birth doesn’t match their perception of themselves.
The center is not a single physical clinic. Instead, the transgender center refers to a collection of specialists in disciplines such as endocrinology and psychology who provide care for nonbinary and transgender people. Its website lists several locations that offer such treatment to adult patients.
“The transgender center has never been a physical place,” said Susan Halla, president of the St. Louis Chapter of Transparent, which advocates for transgender kids and their parents. “The ‘center’ is the fact that they had doctors and practitioners from all areas of the hospital. … They will continue to treat transgender patients to the full extent of Missouri law.”
For pediatric patients, the center has been operated out of the endocrinology department at Children’s Hospital, according to a parent of a former patient. But there was not a single building or clinic exclusively for pediatric transgender patients at Washington University, she said.
Is the transgender center still providing care?
According to the center’s website, it offers a full spectrum of care for adult patients, including cross-sex hormones and gender-affirming surgeries.
Before last fall, the center had offered a similar spectrum of age-appropriate treatment for those under 18. But the center stopped providing puberty blockers or hormone therapy to minors last September after state legislators passed a ban on that treatment.
While the law sponsored by Republican state Sen. Mike Moon of Ash Grove allows treatment to continue for minors already getting care, Washington University and other providers ceased providing it to existing patients under 18, citing legal risks.
The law allows former patients to bring legal action against providers if they could prove infertility as a result of gender-affirming medical treatments, and prevents providers from asking patients to sign waivers to protect from future liability.
“The scope of care provided at the Center changed last year after Missouri passed a new law on the subject,” Washington University spokeswoman Julie Flory said in an email. “Since then, we have continued to support our transgender patients appropriately and in accordance with the law. We have no plans to change that approach.”
Washington University will still offer what care it can to pediatric patients under Missouri law, Flory said in an email. Wash U did not respond to follow-up questions asking to clarify whether the center is closing.
Didn’t Missouri legislators outlaw transgender care for minors?
The 2023 Save Adolescents from Experimentation legislation prohibited providers in Missouri from performing gender transition surgeries on minors or providing them with cross-sex hormones or puberty blockers.
(Providers who work with transgender patients have said it is rare for doctors to perform surgeries on those under 18.)
After the ban went into effect, Wash U officials announced the center would focus on providing information and mental health care to pediatric patients. On its website, its list of available services includes patient education, referrals to psychiatrists who can help with gender dysphoria, voice training and connections to community resources.
So what’s changed?
In an interview, Reed said she heard from a hospital employee that the center was closing after one of its founders, Dr. Christopher Lewis, left to practice in another state. Lewis was the only pediatric endocrinologist at the center, Reed said.
Lewis could not be reached for comment. A representative from Transparent said Lewis told her he does not want to discuss changes at the center.
Reed, the former caseworker, has been at the center of the statewide and nationwide push to limit medical gender-affirming care for minors. Reed authored an article in early 2023 on the conservative website the Free Press claiming the center rushed minors into hormone therapies and other treatment.
She echoed the accusations in a sworn affidavit to the Missouri attorney general’s office. Three state agencies are investigating those claims.
Wash U and several families who received treatment at the center disputed Reed’s account, but the assertions added fuel to Missouri legislators' efforts in 2023 to pass the care ban.
Reed said she thinks it’s possible that if the center is disbanded, patients could be routed through individual divisions such as psychiatry.
A St. Louis-area parent of a patient at the transgender center said Wash U recently contacted her to say it was moving her 19-year-old child to a provider who works with adults because Lewis was leaving. Her child was able to continue care at the pediatric center after September since they were over 18, she said.
“Dr. Lewis is actually wrapping up his tenure there as of June 26,” the parent said. “So his leaving does signify the ‘closure’ of the clinic.” St. Louis Public Radio is not using the parent's name to protect her child’s privacy.
She said she could understand if Wash U officials do not want to give a detailed explanation of any changes at the center.
“Wash U, they’ve gotten a lot of flak for closing down the medical part of the clinic," she said. "I’m not surprised they’re being vague.”
